Normally your body adjusts the production of blood cells in the bone marrow, so that the number of blood cells that are made equals the number that are destroyed. If you have polycythemia, the mechanism becomes faulty and your marrow produces far more blood cells than usual.There are two main types of the disorder.

The first, polycythemia vera, is an over­production of red blood cells, granulocytes and platelets.

The second type of polycythemia is called secondary polycythemia. It occurs as a result of an underlying cause such as a severe lung disease, certain kinds of congenital heart disease cigarette and cigarrtte a king, and living at high altitudes. These conditions can prevent the red blood cells from obtaining enough oxygen to pass on to the body’s tissues, and the bone marrow responds by producing many more red blood cells.

There is a third and less important type of the disorder, which is called stress polycythemia or pseudopolycythemia. In this condition, the number of red blood cells in a blood sample is high, but the cause is a decrease in the amount of plasma in the blood. This is usually due to smoking, but it can be caused by taking diuretic drugs or by becoming dehydrated.

Currently, secondary polycythemia and stress polycythemia are not treated directly. Rather, the problems that cause them are dealt with. Polycythemia vera is the most serious form of the disease, however, and it can be treated directly.

What are the Symptoms?

The typical symptoms of polycythemia vera include recurrent headaches, dizziness, a feeling of fullness in the head, and a ruddy complexion. Sometimes there is severe itching, and hot baths make the itching worse. A physician who examines you may find that you have an enlarged spleen.

What are the Risks?

Although polycythemia vera cannot be cured, it is almost always readily controlled by treatment. Many people who have the disease live for many years. Possible complications from the disease include heart attack deep-vein thrombosis stroke peripheral arterial thrombosis, bleeding, and gout .

What Should be Done?

If you have the symptoms of polycythemia, you should see a physician. The physician will arrange for a blood test, which should show whether or not you have some form of the disease. If polycythemia is diagnosed, further tests are necessary to discover which type of the disorder you have. The tests may include additional blood tests, an intravenous pyelogram, or X-rays of the kidneys, and a measurement of blood volume. In this last test, for example, a small amount of radioactive albumin and a small quantity of your own red blood cells labelled with radioactive chromium are injected into a vein in one of your arms, and a blood sample is taken from your other arm about 30 minutes later. Then the volume of red blood cells and plasma in your bloodstream can be determined.

What is the Treatment?

If you have polycythemia vera, you may be able to receive treatment as an out-patient. The first goal of treatment is to lower the number of red cells in your blood to reduce the risk of thrombosis, or blockage from a clot. To do this, about a pint of blood is regularly taken from a vein in your arm. In some cases, this treatment is only needed once to clear up the condition.

Drugs are usually used to control the over­production of blood cells. Depending on what drug your physician prescribes, you may take it in tablet form for several weeks or it may be injected into a vein. Drug treatment may control the disease for up to several years. Treatment is repeated when the blood counts begin to increase again.

What do Doctors call this Condition - Respiratory distress syndrome, hyaline membrane disease

What is this Condition?

Infant respiratory distress syndrome is the most common cause of death in newborns. In the United States alone, it kills 40,000 new­borns every year. The syndrome occurs in premature infants and, if untreated, is fatal within 72 hours of birth in up to 14% of infants weighing less than 5½ pounds (2,500 grams). Aggressive management using mechanical ventilation can improve the prognosis, but a few infants who survive have lung problems. Mild infant respiratory distress syndrome slowly subsides after 3 days.

What Causes it?

Infant respiratory distress syndrome occurs almost exclusively in infants born before the 37th week of development (60% of those born before the 28th week). It occurs more often in infants of diabetic mothers, those delivered by cesarean section, and those delivered suddenly after antepartum hemorrhage.

Although the breathing passages and alveoli (air sacs in the lungs) of an infant’s respiratory system are present by the 27th week of gestation, the chest muscles are weak and the alveoli and capillary blood supply are immature. In respiratory distress syndrome, the premature infant develops widespread alveolar collapse due to lack of a substance called surfactant. This deficiency prevents the lungs from expanding and causes oxygen deficiency.

What are its Symptoms?

While an infant with respiratory distress syndrome may breathe normally at first, he or she usually develops rapid, shallow respirations within minutes or hours of birth, with chest retractions, flaring nostrils, and audible grunting upon exhaling. The infant may also display low blood pressure, fluid retention, and decreased urine output. In severe disease, symptoms include absence of breathing, slow heart rate, and bluish skin discoloration.

How is it Diagnosed?

While signs of respiratory distress in a premature infant during the first few hours of life strongly suggest respiratory distress syndrome, a chest X-ray and arterial blood gas analysis are necessary to confirm the diagnosis.

When a cesarean section is necessary before the 36th week of development, amniocentesis helps to assess prenatal lung development and, thus, the risk of infant respiratory distress syndrome.

How is it Treated?

Treating a newborn with infant respiratory distress syndrome requires vigorous respiratory support. Warm, humidified, oxygenen­riched gases are given by oxygen hood or, if such treatment fails, by mechanical ventilation. Treatment also includes:

• a radiant infant warmer or isolette for regulation of body temperature

• intravenous fluids

• tube feedings or total parenteral nutrition if the infant is too weak to eat

• administration of surfactant by an endotracheal tube.

What can the parents of an Infant with Respiratory Distress Syndrome do?

• Learn about your infant’s condition and, if possible, participate in care to promote normal parent-infant bonding .

• Be aware that full recovery may take up to 12 months.

What is this Condition?

Metabolic alkalosis is an acid-base imbalance in the body fluids caused by too little acid or too much of a base compound called bicarbonate. Metabolic acidosis is always brought on by some other illness. This imbalance causes metabolic, respiratory, and kidney effects and, especially, depressed breathing.

With early diagnosis and prompt treatment, the chance of correcting this chemical imbalance is good. However, untreated metabolic alkalosis may lead to coma and death.

What Causes it?

Metabolic alkalosis is caused by loss of acid compounds or retention of base compounds in body fluids due to various disorders or drug actions. The body fluids become more alkaline than acid.

Acid Loss

Causes of critical acid loss include vomiting, excessive suctioning of the stomach with a tube, abnormal openings in the stomach (such as perforation caused by ulcers), and the use of certain drugs, including corticosteroids and diuretics. Diseases that cause acid loss include hyperadrenocorticism, Cushing’s disease, hyperaldosteronism, and Bartter’s syndrome.

Base Retention

Causes of base retention include excessive intake of bicarbonate of soda or other antacids (usually for treatment of gastritis or peptic ulcer), toO much alkali (as in milk-alkali syndrome with peptic ulcers), or too much intravenous fluid containing bicarbonate.

What are its Symptoms?

Symptoms begin when the person’s body tries to correct the acid-base imbalance, primarily through hypoventilation, which causes slow, shallow respirations. The person also may feel irritable, pick at his bedclothes, twitch, act confused, and complain of nausea, vomiting, and diarrhea. Because the heart, circulation, and breathing are all disturbed, the person with uncorrected alkalosis may have seizures and fall into a coma.

How is it Diagnosed?

Because the person is often in the hospital for another disorder, the doctor can observe his or her symptoms and then confirm metabolic alkalosis with blood tests and urine tests. The most important test for detecting metabolic alkalosis is called arterial blood gas analysis. The doctor may also use an electrocardiogram to determine the effects of this imbalance on the heart’s function.

How is it Treated?

The doctor tries to correct the underlying cause of metabolic alkalosis - for example, by discontinuing the use of drugs such as diuretics or stopping stomach suctioning. Fluids and elements such as potassium may need to be replaced. For the person with severe alkalosis, the doctor may prescribe intravenous ammonium chloride or other solutions to restore the person’s chemical balance.

What is this Condition?

Gallbladder cancer is rare, accounting for fewer than 1 % of all cancers. The disease occurs mostly in women over age 60. It progresses rapidly and has a poor prognosis because it’s usually diagnosed late.

Bile duct cancer accounts for approximately 3% of all cancer deaths in the United States. It occurs in both men and women between ages 60 and 70. Typically, the cancer spreads to local lymph nodes as well as the liver, lungs, and peritoneum.

What Causes it?

Many doctors consider gallbladder cancer a complication of gallstones, although this theory is based on circumstantial evidence ­ 60% to 90% of people with gallbladder cancer also have gallstones.

At diagnosis, the doctor often finds that the cancer has spread to the lymph nodes. Direct spread to the liver is common, and direct spread to both the cystic and common bile ducts, stomach, colon, duodenum, and jejunum also occurs, causing blockages. The cancer also spreads to the peritoneum, ovaries, and lower lung lobes.

The cause of bile duct cancer isn’t known; however, statistics show an unexplained increased incidence of this cancer in people with ulcerative colitis. This link may result from a common cause - perhaps an immune mechanism or chronic use of certain drugs by people with colitis.

What are its Symptoms?

The symptoms of gallbladder cancer are almost indistinguishable from those of gallbladder inflammation: pain in the upper middle or upper right part of the abdomen, weight loss, loss of appetite, nausea. vomiting, and jaundice. However, chronic, progressively severe pain in someone without a fever suggests cancer. In people with simple gallstones, pain is sporadic. Another telling clue to cancer is a palpable gallbladder with obstructive jaundice. Some people may also have an enlarged liver and spleen.

Progressive profound jaundice is commonly the first sign of obstruction due to extrahepatic bile duct cancer. The jaundice is usually accompanied by chronic pain in the upper middle or upper right part of the abdomen, radiating to the back. Other common symptoms include itching, skin problems, loss of appetite, weight loss, chills. and fever.

How is it Diagnosed?

No one test can diagnose gallbladder cancer. However, lab tests support this diagnosis when they suggest liver problems and extrahepatic biliary obstruction.

How is it Treated?

Surgery relieves symptoms but doesn’t cure the disease. It includes various procedures, such as gallbladder removal, common bile due exploration, tube drainage, and wedge excision of liver tissue. Surgery should normally be performed to relieve obstruction and jaundice that result from extrahepatic bile duct cancer.

Other measures to help relieve symptoms include radiation, radiation implants (mostly used for local and incisional recurrences), and chemotherapy (with combinations of fluorouracil, doxorubicin, and lomustine). All of these treatment measures have limited effects.

What can a Person Undergoing Surgery do?

• After biliary surgery, you’ll probably want to take shallow breath. To improve your breathing, you may receive pain relievers and be instructed to splint your abdomen with a pillow or an abdominal binder.
• Be aware that you’ll have a nasogastric tube in place for 24 to 72 hours after surgery to relieve distention, as well as a T tube.

Nails usually become deformed and/or discolored by injury or illness. Injury to the nail-forming area beneath the cuticle, which is sometimes caused by continuous pressure from poorly fitted shoes or by a decrease in the circulation due to arteriosclerosis , can lead to thickening of the whole nail. Many disorders can produce nail deformities. Psoriasis , lichen planus , and chronic paronychia can cause the trimmed end of the nail to separate from the underlying skin. Bacteria entering this space may make the nail turn blackish-green. Iron-deficiency anemia can make nails spoon­shaped. Lung cancer and congenital heart disease can cause clubbing, or knobby enlarged ends of the fingers and toes, and the nails may grow around these ends. After any illness, temporary poor nail growth may cause a crosswise groove to appear in your nails. This gradually grows out and disappears.Discoloration of a nail is caused by various illnesses. The nail bed appears pale in anemia , and white in chronic liver disease. Small, black, splinter like areas appear under the nails in infections of the heart valves , in systemic lupus erythematosus , and in dermatomyositis.

An injury to the nail, or very rarely a vitamin or mineral deficiency, can cause one or more small white patches to appear in the nail and move out with the nail as it grows. Finally, the nail of the big toe sometimes curves under at the sides, catches in the flesh there and digs in, causing pain as the nail grows. This is an ingrown toenail. It is believed that the nail causes an injury to the skin that does not heal.

What Should be Done?

Deformities and discoloration caused by an underlying illness grow out after the illness is over. Nails badly damaged by injury usually grow again naturally in about nine months. A nail that persistently grows in a deformed manner should be seen by your physician. He or she may be able to correct the problem.

If you have an ingrown toenail, try the following self-help measures. Wear loose fitting shoes, keep the area clean and dry, and cut the nail straight across the top. If the pain increases or persists see your physician.

Occasionally, your physician may recommend a minor operation to remove the in growing edge of the nail and the toe’s nail fold next to it. After the operation, your discomfort will be relieved, but you should follow the self-help treatment described, so that the condition does not recur.